SACRAMENTO: Over a dozen bills to implement and improve upon the new federal health law are now starting to be heard in the California legislature. Lawmakers seek to have their measures heard by policy committees (for these bills, largely the Assembly Health Committee or the Senate Health Committee) in April before the deadline in early May.

JUST ONE YEAR SINCE ACA ENACTMENT: The proposed state legislation builds upon the passage of the federal Patient Protection and Affordable Care Act (ACA), and on subsequent state legislation last year that began its implementation. The federal law celebrated its one-year anniversary of enactment on March 23rd, and a recent Health Access report detailed how many Californians were taking advantage of the new benefits, options, and consumer protections.

Last year’s successes put Caifornia ahead of many other states in making health reform a reality for our residents, but both health advocates and lawmakers advise there is much more work to be done to maximize the benefit for California and Californians, and to ensure a smooth glidepath leading to the full federal health reform implementation in 2014.

PROGRESS ON INSURANCE RATES, BUT MORE TO GO: The debate over the Affordable Care Act put a national spotlight on insurance company rates, particularly here in California. The federal law, along with the state legislation SB1163 (Leno), which went into law on January 1, 2011, gave both the Department of Managed Health Care (DMHC) and the California Department of Insurance (DOI) the ability to better scrutinize rate increases. Insurance rate hikes now must go through public rate review, including public justification of actuarial soundness. As a result of these new requirements and aggressive oversight by Insurance Commissioner Dave Jones, Anthem Blue Cross announced that would reduce their rate hikes, and Blue Shield of California withdrew their 2011 rate increases.

But while the new federal and state laws, and aggressive agency oversight, show that scrutiny matters, the regulators are lacking a specific tool: the explicit ability to approve or deny rates. A bill to institute rate regulation over health insurance, AB52(Feuer), which is supported by a range of consumer advocacy organizations, including Health Access California, is currently pending and may come before the Assembly Health Committee as early as Tuesday, March 4th. It would take the next important step of allowing regulators to explicitly deny unreasonable or unjustified rate increases. Senator Feinstein, who has authored a similar federal proposal, recently came out in support of this state measure.. ACTION ALERT: Call Assembly Health Committee members to urge them to support AB52(Feuer), to protect Californians from unjustified and unreasonable insurance rate hikes.

Many of the measures are specifically related to implementing the Affordable Care Act in California. One big category are bills to ensure that Californians get the care and coverage that they need, through streamlined, simplified eligibility, enrollment, and consumer assistance systems in the state. Another category is a range of bills to implement and provide better consumer protections and insurer oversight. Another area is one around prevention, influencing policy to keep Californians healthy to begin with.

Some legislation that stalled last year will be reconsidered in their new iterations while several new bills would expand Medi-Cal, streamline eligibility and enrollment in public programs, and ensure added consumer protections. Several bills will be heard as early as this week. On Tuesday, the Assembly Health Committee may consider AB52(Feuer) on rate regulation; and bills to mandate the coverage of mental health, AB154(Beall), and maternity services, AB185(Hernandez).

ALERT: SEND ORGANIZATIONAL LETTERS OF SUPPORT: The bills supported by consumer and health groups need organizational letters of support ASAP. Please send letters to the bill’s author, the chairs of the relevant Health Committees (either Senator Ed Hernandez and/or Assemblyman Bill Monning), and members of the relevant policy committee that will review the legislation.

Insurers have already started to get in their opposition letters, and so we need consumer, community, and constituency organizations to submit their letters in support of these specific bills. Contact the author of this update, Linda Leu at Health Access (lleu@health-access.org), for sample letters on some of these bills; a list of health reform related bills is listed below.

* AB 43 (Monning) EXPANDING MEDI-CAL:Expands Medi-Cal eligibility to persons under 133% of the Federal Poverty level who are not pregnant, don’t have dependent children, and are under the age of 65, effective January 1, 2014.

* SB 677 (Hernandez) MEDI-CAL RULES: Implements changes to Medi-Cal required by the ACA including eliminating the asset test and changing income standard to MAGI, effective January 1, 2014.

*AB 1296 (Bonilla) STREAMLINING ELIGIBILITY AND ENROLLMENT: Establishes a single application form and related renewal procedures for Medi-Cal, the Healthy Families Program, and the Exchange, and county programs.

*AB 714 (Atkins) PRE-ENROLLMENT: Requires existing programs such as MRMIB and Family PACT as well as hospitals to provide information about the California Health Benefits Exchange to their members for the purpose of pre-enrolling them into th Exchange to receive subsidized coverage in January 2014.

*AB 792 (Bonilla) AUTOMATIC ENROLLMENT: Ensures continuous coverage through life circumstances such as divorce or unemployment by requiring that consumers receive information about the Exchange when filing for divorce, unemployment, etc. Would also require insurers to provide this enformation to individuals dropping off coverage after 2014.

NEW COVERAGE OPTIONS

* SB 222 (Alquist) COUNTY-RUN HEALTH INSURANCE OPTIONS: Allows counties, county special commissions, or county health authorities that govern, own, or operate a local initiative health plan or county-organized health system to form joint ventures to offer health plans to individuals and groups.

*AB 1066 (Perez) MEDI-CAL WAIVER AND LOW INCOME HEALTH PROGRAMS: Implements the expansion of Medi-Cal as authorized by the Affordable Care Act and the 1115 Medicaid Waiver.

* AB 1334 (Feuer) STANDARDIZING BENEFITS: Requires plans to categorize all products offered in the individual market into five tiers according to the actuarial value and would require disclosure of this and other information.

* AB 154 (Beall) MENTAL HEALTH PARITY: Expands the existing mendal health parity coverage requirement for certain health care service plan contracts and health insurance policies issued, amended, or renewed on or after January 1, 2012, to include diagnosis and treatment of a mental illness of a person of any age.

* AB 151 (Monning) GUARANTEED ISSUES FOR SENIORS ON MEDI-GAP: Assures that those previously covered by MedicareAdvantage have guaranteed issue for Medi-Gap coverage.

* AB 1083 (Monning) REFORMING THE SMALL GROUP MARKET: Conform and phase-in new insurance market rules for small businesses, particularly so that small employers don’t get additional premium spikes based on the health of their workforce.

* AB 727 (Mitchell) HEALTHY AND SUSTAINABLE FOOD: Creates nutrition standards to govern the foods purchased for all state departments, agencies, and state-run institutions in accordance with the federal dietary guidelines. Also creates guidelines for sustainable purchasing practices and procedures that encourage purchasing from local vendors, farms, and manufacturers when feasible.